| NPI | 1952600389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A140831) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.018750) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2021-02-10 |